Pierpaolo Di Micco*, Matteo Giorgi Pierfranceschi, Vincenzo Russo, Nicola Mumoli, Giuseppe Camporese, Corrado Lodigiani, Francesco Dental, Egidio Imbalzano
The pandemic is still on-going but with different ways if compared with first waves of COVID-19. Clinical improvements, advanced therapeutics, vaccination campaign and less virulent viral variants changed the clinical scenario. So in these last months we are observing a cohort of patients admitted in Hospital with acute illness different from fever and lung failure but that show naso pharyngeal swab positive to SARS CoV2 variant OMICRON and on the other hand other cohort of patients with asymptomatic interstitial pneumonia because a recent asymptomatic COVID-19 that should perform a thorough differential diagnosis with other causes of interstitial pneumonia. These clinical findings changed the clinical scenario and updated triage strategy are needed. Patients with lung failure could be always easily identified because associated to typical signs and symptoms have anamnestic relevant data (e.g. immunocompromised patients or antivax people or non-responders to vaccines); yet also patients without recent clinical findings of lung failure may be found with interstitial pneumonia that should be investigated with a thorough differential diagnosis including also the research of SARS CoV2 on nasopharyngeal swab or bronchoalveolar lavage. So, based on knowledge gained in these months of pandemic a strategy to perform diagnosis of COVID-19 also in absence of classic signs and symptoms should be performed taken into account utility of anamnesis, laboratory and microbiological tests and radiological findings. Should we think to adopt diagnostic criteria to perform it in next future?
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